Pharmacy Automation

Pharmacy Automation

PHARMACY AUTOMATION GUIDANCE FOR THE CONTROLLED SUBSTANCE COORDINATOR Part 1: The Inspection Process Pharmacy Informatics Workgroup 1 OBJECTIVES Understand the VHA Handbook 1108.2 requirements that relate to automation

Understand what reports should be requested from the pharmacy prior to performing a routine unit inspection Understand what reports should be reviewed as part of the overall inspection process. Pharmacy Informatics Workgroup 2 The Inspection Process Requirements from VHA Handbook 1108.2

Inspectors should have a password that permits access to the automated dispensing cabinets (ADC) only when accompanied by an authorized user Inspectors must verify source data including a spot check of ADC removals Report any unresolved discrepancies to the controlled substance coordinator for further investigation Review resolved discrepancies for trending purposes Review at least one days worth of ADC restocking Pharmacy Informatics Workgroup

3 Inspecting an Automated Dispensing Cabinet Written instructions on accessing the automated dispensing cabinet in use in your facility to perform a narcotic inspection is a handbook requirement. Pharmacy Informatics Workgroup

4 Strategies for the Inspection Process Temporary Password Set Up When setting up passwords for the facility inspectors, they may be set up with a temporary password. The password can be set up to expire within a selected amount of time. Pharmacy Informatics

Workgroup 5 Strategies for the Inspection Process Permanent Password Set Up The facility controlled substance inspectors may be set up with a permanent password that only allows the user to act as a witness. This password will expire every 90 days similar to other passwords.

Pharmacy Informatics Workgroup 6 Conducting the Inspection Area personnel should sign into the automated dispensing cabinet The controlled substance inspector should sign on as a witness Access the controlled substances stored in the cabinet.

Count the items in each drawer or pocket Look for any discrepancy in count Pharmacy Informatics Workgroup 7 Reports to Request for Inspection Inspectors must verify source data including a spot check of ADC removals The handbook requires that the

inspectors verify provider orders in the inpatient or clinical setting Request one day of activity for busy areas or a week to a month of activity for areas that use few controlled substances Pharmacy Informatics Workgroup 8 Other Reports to Use in the Inspection of Specialty

Areas Specialty areas such as Operating Rooms, Cardiac Cath Labs or Colonoscopy Suites may require other reports to verify documentation of administration OR Reports Case Reports Waste/Return Reports Pharmacy Informatics Workgroup 9

Automation Specific Controlled Substance Activity Reports AcuDose Rx: Controlled Substance Dispense Report MedSelect: Controlled Substance Inventory Summary Omnicell: Transactions by Date or Specific Criteria Report Pandora: Med Usage Report/All Station Events Pyxis: All Station Events Pharmacy Informatics

Workgroup 10 Delbert Siegmund, Pharm.D. Chief of Pharmacy Danville VAMC Pharmacy Informatics Workgroup 1

1 Verifying Inpatient Orders in CPRS Verify five randomly selected patients to make sure that there is an administration to a patient recorded for the dose(s) removed. If your machine allows the addition of emergency or temporary cases, check to see that they are reconciled with the patients permanent records. Pharmacy Informatics

Workgroup 12 Verifying Inpatient Orders in CPRS Access the patient and go to the meds or orders tab and find the order for the medication. Double click on the order and scroll to the bottom of the inpatient medication details box. Look for the date and time of the

administration for the episode on your report Pharmacy Informatics Workgroup 13 CPRS Screenshot of Meds Tab Pharmacy Informatics Workgroup 14

CPRS Screenshot of Inpatient Medication Details Scroll Down Pharmacy Informatics Workgroup 15 CPRS Screenshot of Inpatient Medication Details cont.

Pharmacy Informatics Workgroup 16 CPRS Screenshot of Inpatient Medication Details (IV example) Pharmacy Informatics Workgroup

17 BCMA Administration Reports Available in BCMA under Med Administration History Can also access Med Administration Log if the episode is recent Both reports are available in CPRS on the Reports tab Pharmacy Informatics

Workgroup 18 BCMA Medication Admin History Report Pharmacy Informatics Workgroup 19 BCMA Reports available in

CPRS Reports Tab Pharmacy Informatics Workgroup 20 Verification of Orders in Outpatient Areas Outpatient Units Colonoscopy Suite Same Day Surgery Cardiac Catheterization Suite

Work with HAS and Pharmacy to have clinic stop added to the unit Area personnel should not have to add patients on a routine basis. Pharmacy Informatics Workgroup 21 Verification of Orders in Outpatient Areas Outpatient CPRS prescription (ex Methadone maintenance)

OR Report (Same Day Surgery) Case Note (Cardiac Cath Lab, Colonoscopy Suite) Pharmacy Informatics Workgroup 22 Jennifer Howard, Pharm.D. Director, Pharmacy Informatics San Diego VAMC

Pharmacy Informatics Workgroup 23 Methadone Maintenance Unit AMS Avatar System Verify opening amount, amount dispensed, quantity on hand. Verify 5 orders as previously outlined

Pharmacy Informatics Workgroup 24 Review Discrepancies Ideally, you should also look at both unresolved and resolved discrepancy reports Report any unresolved discrepancies to the controlled substance coordinator for further investigation Review resolved discrepancies for

trending purposes Pharmacy Informatics Workgroup 25 Automation Specific Discrepancy Reports AcuDose Rx: Discrepancy by Station, Open Discrepancy By Station MedSelect: Top 25 discrepancies Omnicell: Pharmacy Discrepancy Report

Pandora: Discrepancy Report Pyxis: All Discrepancies Pharmacy Informatics Workgroup 26 Verification of Restock The handbook requires that the at least one days worth of restocking be verified as part of the inspection process. A report of restocks will need to be generated from the Pharmacy narcotic

vault. This report may come from Vista, Pyxis CII Safe or Omnicell Secure Vault Pharmacy Informatics Workgroup 27 Automation Specific Restock Reports AcuDose Rx: Loading and Unloading Report MedSelect: Restock Summary

Omnicell: Transactions by Date or End of Cycle Report (if site has Secure Vault) Pandora: Narc Vault Reconciliation Report Pyxis: Med Refill Activities Pharmacy Informatics Workgroup 28 End of Shift Count End of Shift Count or Weekly Count

Not a handbook requirement May be required by local policy End of shift discrepancy report Best Practice Pharmacy Informatics Workgroup 29

Inspecting the Pharmacy Narcotic Vault Automation that may be present in the vault Pyxis CII Safe or Omnicell Secure Vault Fast Fill Scriptpro SP50 Baker Cells Pharmacy Informatics Workgroup

30 Inspecting the Pharmacy Narcotic Vault Pyxis CII Safe Omnicell Secure Vault Pharmacy Informatics Workgroup 31 Inspecting the Narcotic

Vault Pharmacy Dispense without (VA FORM 10-2638) LORAZEPAM 0.5MG TAB,UD Select NAOU: xx QUANTITY DISPENSED (TAB/25): 25// 25 JAN 01, [email protected]:21:51 DISP OMNICELL XX -25 Pharmacy Informatics Workgroup 32

Outpatient Robotic Prescription Fill Fast Fill Baker Cells ScriptPro Pharmacy Informatics Workgroup 33 Questions???

Marian Daum - Coatesville VAMC Delbert Siegmund - Danville VAMC Jennifer Howard - San Diego VAMC Dionne Roney - Charleston VAMC Jolene Hallcroft - Sheridan VAMC Pharmacy Informatics Workgroup 34

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